Al Muqarrab Fatimah, Schwartz Robert A, Almohssen Amer A
Fatimah Al Muqarrab, Consultant , Dermatologist, Saudi Board of Dermatology, Arab Board of Dermatology and V enereology, Al Ashaa, Saudi Arabia;
Acta Dermatovenerol Croat. 2022 Dec;30(4):227-236.
severe distinctive cutaneous drug reaction, generalized pustular figurate erythema, closely linked with hydroxychloroquine (HCQ), has been documented. It is distinguishable from AGEP by its longer incubation, more varied morphology (initially urticarial and later targetoid, arcuate plaques), recalcitrance to therapy and longer disease course. Aim of the article is to review the recognized entity associated with ingestion of hydroxychloroquine in patients infected with COVID-19. A systematic review using electronic search was performed. Inclusion criteria: n patients with COVID-19 demonstrated by PCR, with typical clinical features of AGEP/GPFE or atypical features associated with typical histopathology. We used the (JBI) Critical Appraisal Checklist for Case Reports for the qualitive assessment. We included 13 publications. Their overall quality was good to moderate. Only 27.3% of the patients had a severe COVID-19 course. The mean lag time between trigger exposure and rash development was 24 days. Only 15.38% of the reported AGEP were clinically typical, while the remaining 69.23 % were suggestive of GPFE. Unfortunately, 2 patients died secondary to massive pulmonary embolism. In COVID-19 infection, we suggest reconsidering treating established COVID-19 empirically with HCQ, as both triggers can augment the subsequent cytokine storm, inducing a severe drug reaction and possibly increasing the risk of thrombo-embolic events.
已记录到一种与羟氯喹（HCQ）密切相关的严重特异性皮肤药物反应，即全身性脓疱状图案红斑。它与急性泛发性发疹性脓疱病（AGEP）不同，其潜伏期更长，形态更多样（最初为荨麻疹样，随后为靶形、弓形斑块），对治疗反应不佳且病程更长。本文的目的是回顾在感染新型冠状病毒肺炎（COVID-19）的患者中与摄入羟氯喹相关的已确认病症。进行了一项使用电子检索的系统综述。纳入标准：经聚合酶链反应（PCR）证实为COVID-19的患者，具有AGEP/全身性脓疱状图案红斑（GPFE）的典型临床特征或与典型组织病理学相关的非典型特征。我们使用循证卫生保健国际协作网（JBI）病例报告批判性评价清单进行定性评估。我们纳入了13篇出版物。它们的总体质量为良至中等。只有27.3%的患者患有严重的COVID-19病程。触发暴露与皮疹出现之间的平均滞后时间为24天。报告病例中只有15.38%的AGEP在临床上是典型的，而其余69.23%提示为GPFE。不幸的是，2例患者死于大面积肺栓塞。在COVID-19感染中，我们建议重新考虑对确诊的COVID-19患者经验性使用HCQ进行治疗，因为这两种触发因素都可能加剧随后的细胞因子风暴，引发严重的药物反应，并可能增加血栓栓塞事件的风险。
